The unsung heroes

MASERU-As businesspeople heaved a sigh of relief following the lifting of the lockdown last Tuesday, for midwife, Mamello Makhele, the action had a much bigger meaning – saving mothers from pregnancy-related deaths.For the duration of the lockdown, imposed to prevent the spread of coronavirus at the beginning of April, Makhele, a midwife at Katse Health Centre, had been in anguish.

Due to lack of reliable public transport as a result of the lockdown, many of her patients could not access much-needed lifesaving medical services.Her work is her passion and seeing women go without the services that could save their lives and that of their babies left her with a feeling of desperation.

Child deliveries became dangerous during the lockdown, as some women were forced to give birth in unsafe home deliveries.“It wasn’t because there were soldiers but because they travel long distances to get to the clinic,” she said, adding that “there were no taxis”.Makhele told thepost in a telephone interview that she is happy because she can now resume her duties without hindrances.

“Now the women have resumed their ante-natal visits,” Makhele said, adding that the situation got so desperate that at one time she had to assist a woman in one village deliver her baby at home during the lockdown.People who come to Katse Health Centre often travel long distances for services, with some travelling for up to 10 hours from places such as Senqunyane.

It was not only pregnant women that got Makhele worried.In one of her catchment areas, family planning pills and services became unavailable.“This is because of the disturbed global chain supply,” she said.“Airports and border posts are closed. How are we going to get FP (family planning)’s from India to Lesotho?” she said. “This is just an assumption that there will be a decline in FP intake.”

Makhele foresees an influx of teenage pregnancies because young people are more exposed to sexual activities when they are idle.“During the lockdown there is really not much to do as a form of entertainment especially when schools are closed,” she said.

“They get married young too because they are in a cultural setting that has normalised getting married young. Our teenage corner is closed because of the Covid-19 and this has also contributed to the challenges they face,” she said.

Statistics also show that gender-based violence was on the rise during the lockdown and this may translate into a rise in unplanned pregnancies, Makhele said.She said amidst the turmoil, the country should celebrate the unsung heroes of health during this lockdown because they have made “mighty strides to put the health system in the position it is today”.

She said service delivery is better than during the past years. “More people are accessing health services and there is more mobilisation of information for people who have stayed uninformed.”Midwives are the cornerstone of Sexual Reproductive Health Rights (SRHR) of women.

“We have done well to save a lot of lives and bring lives into the world,” Makhele said.“Midwives play an essential role and they go beyond the call of duty in ensuring a safe delivery of a baby and its mother,” she said.“Not only to ensure safe delivery but you take a mother through the stages of pregnancy, labour stage and post-partum and until the baby is five years old.”

She said in the rural areas, midwives help young mothers as young as 13 years old who go through a lot of emotions.“Midwives ease the journey of these young mothers, encouraging them through the journey, advising them. Some of them were forced into child marriages.”

“Midwives in the rural areas are the pillars of the health system. They offer services against all odds and go beyond the call of duty”.Makhele’s passion for her job brings to mind the words of Robin Lim, a US midwife and founder of Yayasan Bumi Sehat (Healthy Mother Earth Foundation) health clinics, which offer free prenatal care, birthing services and medical aid to anyone who needs it.

Robin Lim’s famous quote says: “After disasters, reproductive healthcare falls by the wayside. Yet babies continue to be born. When all infrastructure falls apart, when the hospitals and all their technological equipment are destroyed, midwives come in handy. They can help a woman give birth with or without electricity, running water, equipment- even shelter is optional. When babies are ready, they come.”

This quote depicts the realities of midwives in Lesotho.Most endure tough conditions in rural areas where women deliver in the absence of essential basics such as adequate shelter, electricity and running water.

On Tuesday last week, the world celebrated International Day of the Midwife during the Covid-19 epidemic that has killed over 290 000 while infecting another 4.8 million people worldwide.Lesotho has one confirmed case of the Covid-19 disease.In February the Ministry of Health, in collaboration with nursing institutions and associations in the country, launched the 2020 international year of the nurse and midwives.

According to the United Nations Populations Fund (UNFPA)’s Lesotho suppliers’ coordinator, Tšeliso Masilo, the trends of women on contraceptives, antenatal clinic visits by skilled labour, skilled birth attendance, institutional delivery and post natal care has changed over the years.

Different statistics from Lesotho Demographic Health Survey (LDHS) of 2004, 2009, 2014 and Multiple Indicator Cluster Survey (MIC’s) reports demonstrate a health shift and positive growth in health accessibility.The reports show that contraceptive intake among married women has increased from 35 percent in 2004 to 64.9 percent in 2018.

They also show that ante-natal skilled provider increased from 90 percent in 2004 to 91.3 percent in 2014, skilled birth attendance between 2004 and 2018 has increased from 55 percent to 86 percent while institutional delivery from 52 percent to 89.4 percent and post natal care from 39 percent to 84 percent.

All of this work and more is done by a nurse midwife in Lesotho.Unlike in the past years when nurses and midwives would gather to celebrate the day, the outbreak of coronavirus has made this year different.Covid-19 has disrupted the usual celebratory gatherings due to demands of social distancing and avoiding closed congested spaces.

In a statement marking the day, the UNFPA Executive Director Dr Natalia Kanem said in countries hard hit by the Covid-19 crisis, midwives are dying due to lack of personal protective equipment (PPE) and overall lack of support.

She said midwives are redeployed to respond to the crisis and this leaves women without access to life saving, time critical services.